Objective — to study the influence of the introduction of a complex of measures, aimed at the creating of motivation for the treatment of patients with tuberculosis.
Materials and methods. Survey among patients about their level of knowledge about TB and reasons for discontinuation of the treatment, the regional program and the order of consultative office, analysis of treatment of patients with tuberculosis for 2006—2013 years in the region of Zaporizhzhia.
Results and discussion. At Zaporizhzhia region were developed methods, that helped attract patients to seek treatment, such as: the direct control of the intake of anti-TB drugs, providing psychological aid to patients, organization of the social support for patients with newly diagnosed tuberculosis during outpatient treatment in the form of food and hygiene kits. That became possible thanks to collaboration of anti-TB services with various agencies, international, public and charitable organizations. In the region, the number of TB treatment interruptions significantly decreased (30 % in 2006 and 2.8 % in 2013). Basic TB epidemic indicators also were improved for the last 8 years: the incidence decreased by 24.8 %, mortality — by 31.6 %.
Conclusions. Application of a complex of social and psychological activities aimed at increasing the motivation of patients with tuberculosis towards the treatment, in the form of comprehensive social support and focused adequate sanitary work, that significantly influenced on the improvement of the epidemiological situation of tuberculosis in the region, which gives opportunity to effectively withstand to adverse conditions of the spread of the disease.

Keywords: newly diagnosed pulmonary tuberculosis, propensity for treatment of tuberculosis, interruption of treatment, social and psychological support, stationary, outpatient treatment stage, sanitary ­awareness work

List of references:  
1.    Єсипенко С.В., Філюк В.В., Герасименко Н.А. Аналіз причин поширеності мультирезистентного туберкульозу в Одеській області // Туберкульоз, легеневі хвороби, ВІЛ-інфекція.— 2014.— № 3.— С. 85—89.
2.    Нізова Н.М., Павлова О.В., Щербинська А.М., Стель­мах О.М. Туберкульоз в Україні: аналітично-статистичний довідник.— К., 2015.— С. 14.
3.    П’ятночка І.Т., Корнага С.І., Тхорик Н.В. Про прихильність до лікування хворих на туберкульоз // Туберку­льоз, легеневі хвороби, ВІЛ-інфекція.— 2015.— № 1.— С. 108—111.
4.    Петренко В.І. До міжнародного дня боротьби з туберкульозом: «Охопити три мільйони: виявити, лікува­ти, вилікувати туберкульоз» // Туберкульоз, легеневі хвороби, ВІЛ-ін­­фекція.— 2014.— № 1.— С. 5—7.
5.    Фещенко Ю.І., Мельник В.М., Марусевич В.Г. Організа­ція протитуберкульозної санітарно-освітньої роботи в Україні: метод. реком.— К., 2001.— С. 1—15.
6.    Ясінов Д.А., Полувінко І.О., Смагіна Л.Т. Ефективність психологічного супроводу прихильності до лікування туберкульозу на стаціонарному етапі // Туберкульоз, легеневі хвороби, ВІЛ-інфекція.— 2014.— № 1.— С. 55—59.

Objective — to determine the efficacy of treatment MDR and XDR tuberculosis at the end of the initial phase of chemotherapy (IP) and treatment outcome and to determine the main reasons for poor results.
Materials and methods. Retrospective cohort study included 440 patients with MDR TB and 158 with XDR TB. The efficacy of treatment were analyzed at the end of the initial phase of chemotherapy and primary treatment. The patients were divided into groups (new cases of tuberculosis, patients who received treatment only I line of anti­TB drugs and received I—II line of anti­TB drugs). The patient were compare on age, sex, prevalence of infiltrations in lung, the number and size of destruction, regimens of chemothe­rapy. The regimens has been included 4 effective anti­TB drugs daily in medium therapeutic doses; if it wasn’t possible to includ 4 effective anti­TB drugs, administered drugs from 5th group.
Results and discussion. Among patients with MDR TB (without XDR TB) were achieved: «successful treatment» in 62.0 % of patients with new cases of tuberculosis and in 53.7 % of patients who were treated only I line of anti­TB drugs (p > 0.05), in comparison 38.1 % of patients who had a history of previous treatment with II line of anti­TB drugs (p < 0.05). At the end of IP were achieved: sputum conversion at 88.0 % and 79.3 % patients against 63.1 % patients, respectively (p < 0.05). LTFU lower among patients who are not previouses treated late. Term of culture conversion in patients with MDR­TB on 1 month shorter in new cases and received I line of anti­TB drugs in comparison patients received I—II line of anti­TB drugs (p < 0.05). Established trend among patients with XDR TB that efficacy of treatment is higher in patient with new cases of tuberculosis and who was treated only I line of anti­TB drugs in comparison who was treated with II line of anti­TB drugs: «successful treatment» were in 53.3, 38.7 % in comparison 28.5 % (p > 0.05); at the end of IP culture conversion were at 66.7, 64.5 % in comparison 50.9 % of patients, respectively (p > 0.5). Term of culture conversion in patients with XDR­TB exceeded an average of 3.5 months and don’t depend of previous treatment.
Conclusions. Evaluation of the treatment outcome should be done separately in patients with MDR and XDR, and separately in patients who treated or not in the past II line of anti­TB drugs. Due to lowest treatment efficacy among patients with MDR TB to XDR TB especially among patients treated in previous II line of anti­TB drugs, for them as appropriate: include at the regimen of chemotherapy drugs 5th group or new anti­TB drugs (bedakvilin, delamanid). Considering the high level of LTFU in those patients, we recommended to provide full social support for them. Given that the loss of efficacy of treatment occurs at the continuational phase of treatment, the main efforts should be directed at improving the quality of care for ambulatory phase of treatment, and the development and implementation of new shorter chemotherapy regimens.

Keywords: multidrug­resistens tuberculosisis, extensively drug­resistens tuberculosisis, sputum con­version, effective treatment.

List of references:  
1.    Белостоцкий А.В. и др. Проблема приверженности больных туберкулезом к лечению // Туберкулез и болезни легких.— 2015.— № 4.— С. 4—8.
2.    Про затвердження уніфікованого клінічного протоколу первинної, вторинної (спеціалізованої) та третинної (високо­спеціалізованої) медичної допомоги «Туберкульоз»: Наказ МОЗ України № 620 від 09.09.2014 р.— К., 2014.— 128 с.
3.    Туберкульоз в Україні: аналітично-статистичний довідник МОЗ України.— К., 2015.— 104 с.
4.    Comolet T. Multidrug-resistant tuberculosis: challenges of a global emergence // Bull. World Health Organ.— 2015.— Vol. 93, N 4.— P. 279—282.
5.    Duraisamy K. et al. Does Alcohol Consumption during Mul­tidrug-resistant Tuberculosis Treatment Affect Out­come? // Ann. Am. Thorac. Soc.— 2014.— Vol. 5, N 11.— P. 712–718.
6.    Fourati S. et al. Multidrug-resistant tuberculosis: Epidemiology and risk factors // Rev. Pneumol. Clin.— 2015.— Vol. 71, N 4.— P. 233—241.
7.    Kamal S.M. et al. Anti-tuberculosis drug resistance in Bang­ladesh: reflections from the first nationwide survey // Int. J. Tuberc. Lung Dis.— 2015.— Vol. 19, N 19.— P. 151—156.
8.    Tang S. et al. Risk Factors for Poor Treatment Outcomes in Patients with MDR-TB and XDR-TB in China: Retrospective Multi-Center Investigation // PLoS One.— 2013.— Vol. 8, N 12.— P. e82943.
9.    Trauner A. et al. Evolution of Drug Resistance in Tuberculosis: Recent Progress and Implications for Diagnosis and Therapy // Drugs.— 2014.— Vol. 74.— P. 1063—1072.
10.    World Health Organization. Global tuberculosis report 2015.— Geneva: WHO, 2015.

Objective — to evaluate the clinical course of the lung cancer (LC) in men and women (localization, shape, histopathologic variant, degree of differentiation, staging, character of tumor metastasis) and survival of the patients with different sexes.
Materials and methods. The study included 1071 patients with lung cancer at the age of 24 to 86 years, among whom there were 887 (83 %) men and 184 (17 %) women. None of the examined patients on account of the underlying disease have been operated previously, and after diagnosis all the patients received radiotherapy, 3/4 of them — combined radio chemotherapy.
Results and discussion. The frequency of distribution of men and women with LC is at 5 : 1. Gender­specific RL related to the localization of the pathological process (in men more often in the left and in the mediastinum, women — in the right, locally in the upper, middle and lower lobes), the staging’s parameters of the tumor in the manifest onset of the disease (in women a higher level), form of tumors (the prevalence of central form in men and peripheral — in women), the frequency of squamous cell carcinoma in men and adenocarcinoma in women. The metastasis to the mediastinal lymph nodes, kidneys and thighs is typical for men, in the subclavian, inguinal lymph nodes, thyroid, brain, eyes, abdominal wall, jaws, clavicles, spine, pubic, sacral, ilium bones, sacroiliac and the hip joint for women.
Conclusions. There is sexual dimorphism in the clinical course of LC, but the 3­ and 5­year survival rate of the patients were the same. The data will be useful for the development of rational medical technologies for diagnostic of LC in men and women, and radiochemotherapy of the patients with different sexes.

Keywords: cancer, lung, clinical course, men, women.

List of references:  
1.    Онкология / Под. ред. Г.В. Бондаря, Ю.В. Думанского, А.Ю. Поповича.— К.: Медицина, 2015.— 576 с.
2.    Akhtar-Danesh N., Finley C. Temporal trends in the incidence and relative survival of non-small cell lung cancer in Canada: A po­­pu­la­tion-based study // Lung Cancer.— 2015.— Vol. 90, N  1.— P. 8—14.
3.    Brückl W.M., Al-Batran S.E., Ficker J.H. et al. Estrogen receptors and their impact for prognosis and therapy of lung cancer — new insights to an underestimated mechanism // Pneumologie.— 2015.— Vol. 69, N 6.— P. 350—360.
4.    Ceniceros L., Aristu J., Castanon E. et al. Stereotactic body radiotherapy (SBRT) for the treatment of inoperable stage I non-small cell lung cancer patients // Clin. Transl. Oncol.— 2015.— Vol. 55, N 8.— P. 213—219.
5.    Grаdalska-Lampart M., Karczmarek-Borowska B., Radziszew­ska A.U. Lung cancer in Podkarpackie region in the years 2002—2011 // Pneumonol. Alergol. Pol.— 2015.— Vol. 83, N 2.— P. 109—119.
6.    He Y.F., Luo H.Q., Wang W. et al. Clinical features and prognosis-associated factors of non-small cell lung cancer exhi­biting symptoms of bone metastasis at the time of diagnosis // Oncol. Lett.— 2015.— Vol. 9, N 6.— P. 2706—2712.
7.    Honma N., Hosoi T., Arai T., Takubo K. Estrogen and cancers of the colorectum, breast, and lung in postmenopausal women // Pathol. Int.— 2015.— Vol. 65, N 9.— P. 451—459.
8.    Kukulj S., Popovic F., Budimir B. et al. Smoking behaviors and lung cancer epidemiology: a cohort study // Psychiatr. Danub.— 2014.— Vol. 26, N 3.— P. 485—489.
9.    Linares I., Molina-Portillo E. et al. Trends in lung cancer incidence by histologic subtype in the south of Spain, 1985—2012: a population-based study Expósito // Clin. Transl. Oncol.— 2015.— Vol. 22, N 9.— P. 152—156.
10.    Lumachi F., Mazza F., Del Conte A. et al. Short-term survival of patients with lung metastases from colorectal and non-colorectal cancer who underwent pulmonary metastasectomy // Anti­cancer Res.— 2015.— Vol. 35, N 6.— P. 3563—3566.
11.    Meza R., Meernik C., Jeon J., Cote M.L. Lung cancer incidence trends by gender, race and histology in the United States, 1973—2010 // PLoS One.— 2015.— Vol. 10, N 3.— E. 0121323.
12.    Molina A.J., García-Martínez L., Zapata-Alvarado J. et al. Trends in lung cancer Incidence in a healthcare area // Arch. Bronconeumol.— 2015.— Vol. 4, N 7.— P. 122—127.
13.    Olajide O.O., Field J.K., Davies M.M., Marcus M.W. Lung cancer trend in England for the period of 2002 to 2011 and projections of future burden until 2020 // Int. J. Oncol.— 2015.— Vol. 47, N 2.— P. 739—746.
14.    Oliveira M.F., Rotta J.M., Botelho R.V. Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status // Arq. Neuropsiquiatr.— 2015.— Vol. 73, N 4.— P. 330—335.
15.    Qu H.M., Bai Y.N., Cheng N. et al. Trend analysis of cancer mortality in the jinchang cohort, China, 2001—2010 // Biomed. Environ. Sci.— 2015.— Vol. 28, N 5.— P. 364—369.
16.    Salomaa E.R., Walta M. The prognosis of lung cancer continues to be poor— treatment outcome within the hospital district of Southwest Finland in 2004 to 2011 // Duodecim.— 2015.— Vol. 131, N 1.— P. 69—75.
17.    Shan L., Qiu T., Ling Y. et al. Prevalence and clinicopathological characteristics of HER2 and BRAF mutation in chinese patients with lung adenocarcinoma // PLoS One.— 2015.— Vol. 10, N 6.— E. 0130447.
18.    Ulas A., Bilici A., Durnali A. et al. Risk factors for skeletal-related events (SREs) and factors affecting SRE-free survival for nonsmall cell lung cancer patients with bone metastases // Tumour Biol.— 2015.— Vol. 15, N 8.— P. 161—166.
19.    Vanthomme K., Vandenheede H., Hagedoorn P. et al. Trends in site- and sex-specific cancer mortality between 1979 and 2010 in Belgium compared with Europe using WHO data // J. Public. Health.— 2015.— Vol. 11, N 6.— P. 168—176.
20.    Yu X.Q., Kahn C., Luo Q. et al. Lung cancer prevalence in New South Wales (Australia): Analysis of past trends and projection of future estimates // Cancer Epidemiol.— 2015.— Vol. 39, N 4.— P. 534—538.
21.    Zhou C. Lung cancer molecular epidemiology in China: recent trends // Transl. Lung Cancer Res.— 2014.— Vol. 3, N 5.— P. 270—279.

Objective — the research was the assessment of social features of patients with pulmonary tuberculosis for improving the policy recommendations in strengthing tuberculosis control.
Materials and methods. It was performed a retrospective, selective, descriptive study targeting social pecualiarities of 361 patients with pulmonary tuberculosis, diagnosed and hospitalized in the Muncipal Clinical Hospital of Phthysiopneumology of Chisinau in the period of 01.01.2014—01.01.2015.
Results and discussion. The predominance of men (67.8 %), the patients from the group of 18—40 years old (57.98 %) and single civil patients (57.07 %) was identified  by social economical assessment. Most prevalent harmful habits were tobacco smoking (86.42 %) and alcohol abuse (25.21 %). Persons with disadvantaged financial state (60.67 %) and persons without medical insurance (43.76 %) prevailed. In a fewer proportion were labor migrants (6.37 %) and patients with imprisonment history (4.71 %).
Conclusions. Due to major disadvantaged social features of tuberculosis patients updated national social policies must be developed for improving social welfare, targeting  vulnerable patients, with lack of social and health security.

Keywords: tuberculosis, risk factors, social determinants.

List of references:  
1.    Allebeck P. Delay in tuberculosis care: one link in a long chain of social inequities // Eur. J. Pub. Health.— 2007.— Vol. 5.— P. 409—412.
2.    Aveyard H. Literature review in health and social care: A prac­tical Guide, McGraw-Hill, 2010.
3.    Baker M., Das D., Venugopal K., Howden-Chapman P. Tuber­culosis associated with household crowding in a developed country // J. Epidemiol. Community Health.— 2008.— Vol. 62 (8).— P. 715—721.
4.    Bates M.N., Khalakdina A., Pai M. et al. Risk of tuberculosis from exposure to tobacco smoke // Arch. Intern. Med.— 2007.— Vol. 167.— P. 335—342.
5.    Bambra C., Gibson M., Sowden A. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews // J. Epidemiol. Community Health.— 2010.— Vol. 64.— P. 84—291.
6.    Guo N., Marra F. Measyring health-related quality of life in tuberculosis: A systematic review // Health Quality Life Out­comes.— 2009.— Vol. 14.— P. 7—14.
7.    Jenkins H., Ciobanu A., Plesca V. et al. Risk factors and timing of default from treatment for non-MDR TB in Moldova // Int. J. Tuberc. Lung Dis.— 2013.— Vol. 17 (3).— P. 373—380.
8.    Lin H.H., Ezzati M., Murray M. Tobacco smoke, indoor air pollution and tuberculosis: A systematic review and meta-analysis // Plos. Med.— 2007.— Vol. 4.— P. e20.
9.    Lonnroth K., Jaramillo E., Williams B.G. et al. Drivers of tuberculosis epidemics: the role of risk factors and social determinants // Soc. Sci. Med.— 2009.— Vol. 68 (12).— P. 2240—2246.
10.    Nalivaico N. Concepţia internaţională în managementul tuber­culozei în condigiile epidemiologiei contemporane Bule­tinul Academiei de Ştiinţe a Moldovei. Ştiinţe medicale.—Chişinău.— 2011.— Vol. 4 (32).— P. 206—211.
11.    Protocol Clinic National. Tuberculoza la Adult. Chişinău.— 2014.— 120 p.
12.    Todorikо L.D., Ieremenchuk І.V. Features of cytokine regulation and indicators of endogenous intoxication in multidrug-resis­tant pulmonary tuberculosis  // Moldovan J. Health Sci.— 2014.— N 2.— С. 26—35.
13.    United Nations Statistics Division. Millennium Development Goal Indicators Database. http://unstats.un.org/unsd/mi/mi_goals.asp.
14.    World Health Organization. Global tuberculosis control 2011. Epidemiology, strategy, finances. Geneva, 2011.
15.    World Health Organization. Treatment of tuberculosis: guide­lines. Geneva, 2014.
16.    World Health Organization. Commission on Social Determinants of Health. Action on the social determinants of health. Geneva, 2005.
17.    World Health Organization. Equity, social determinants and public health programmes, Geneva, 2010.
18.    http://statbank.statistica.md/pxweb/Database/asp (cited 1.1 2016).

Objective — to analysis of the role of thyroid state in the formation of anti tuberculosis immunity.
Materials and methods. 60 patients with destructive pulmonary tuberculosis were examined between the ages of 18 to 70 years, among them 30 patients were diagnosed suffering from an autoimmune thyroiditis and subclinical hypothyroidism. Immunological investigations were performed before and at the end of the phase of  intensive therapy. The state of T­ and B ­systems of immunity and natural killers were estimated.
Results and discussion. The results highlighted the mechanisms with the help of which endocrine system is able to influence the strengthening of the immunity.
Conclusions. Autoimmune thyroiditis with subclinical hypothyroidism leads to the suppression of the T­cell and humeral immunity in tuberculosis patients. This explains less successful results in antitubercu­losis chemotherapy in patients with comorbidity.

Keywords: tuberculosis, autoimmune thyroiditis, subclinical hypothyroidism, immunity.

List of references:  
1.    Лапач С.Н., Чубенко А.В., Бабич П.Н. Статистичес­кие ме­­тоды в медико-биологических исследованиях с использованием Exel.— К.: Морион, 2000.— 320 с.
2.    Матвеева С.Л. Клиническая характеристика и исходы хи­­мио­терапии туберкулеза легких у лиц с патологией щитовидной железы // Туберкульоз, легеневі хвороби, ВІЛ-ін­­фекція.— 2011.— № 2 (5).— С. 39—44.
3.    Матвеева С.Л. Роль преморбидного тиреоидного статуса в формировании клеточного иммунитета и исходов химиотерапии у больных деструктивным туберкулезом легких // Пробл. ендокрин. патол.— 2011.— № 3.— С. 35—43.
4.    Уніфікований клінічний протокол первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) ме­­дичної допомоги. Туберкульоз.— Наказ МОЗ України від 21.12.2012 № 1091.
5.    Черенько С.А., Матвеева С.Л. Корреляции между клиническим течением туберкулеза легких, функцией щитовидной железы и некоторыми цитокинами // Укр. пульмонол. журн.— 2011.— № 2.— C. 35—38.
6.    Csaba G., Pallinger E.. Thyrotropic hormone (TSH) regulation of triidthyronine (T3) concentration in immune cells // Inflamm. Res.— 2009.— Vol. 58.— P. 151—154.
7.    Csaba G., Rjvaca P., Pallinger E. Immunologically demonstrable hormones and hormone-like molecules in rat white blood cells and mast cells // Cell Biol. Internat.— 2004.— Vol. 28.— P. 487—490.
8.    Davis S.L. Environmental modulation of the immune system via the endocrine system // Domest. Anim. Endocrinol.— 1998.— Vol. 15.— P. 283—289.
9.    Dorshkind K., Horseman N.D. The roles of prolactin, growth factor-I, and thyroid hormones in lymphocyte development and function: insights from genetic models of hormone and hormone receptor deficiency // Endocrine. Rev.— 2000.— Vol. 21.— P. 292—312.
10.    Fabris N., Mocchegiani E., Provinciali M. Pituitary thyroid axis and immune system: a reciprocal neuroendocrine immune interaction // Horm. Re.— 1995.— Vol. 43.— P. 29—38.
11.    Foster M.P., Jensen E.R., Montecino-Rjdriguez E. et al. Humoral and cell-madiated immunity in mice with genetic deficiencies of prolactin, growth hormone, insulin-like growth factor-I, and thy­roid hormones // Clin. Immunol.— 2000.— Vol. 96.— P. 140—149.
12.    Hodkinson C.F., Simpson E.E.A., Beattie J.H. et al. Preliminary evidence of immune function modulation by thyroid hormones in healthy men and women aged 55—70 years // J. Endocrinol.— 2009.— Vol. 202. —P. 55—63.
13.    Provinciali M., Muzzioli M., Di Stefano G., Fabris N. Recovery of spleen cell natural killer activity by thyroid hormone treat­ment in old mice // Nat. Immun. Cell Growth Regul.— 1991.— Vol. 10 (4).— Р. 226—236.
14.    Silbestein S., Vogl A.M., Bonfiglio J.J. et al. Immunology: signal trans­duction, and behavior inhypothalamic-pituitary-adrenal axis-related genetic mouse models // Ann. NY Acad. Sc.— 2009.— Vol. 1153.— P. 120—130.
15.    Stagi S., Azzari C., Bindi G. at al Undetectable serum IgA and low IgM concentrations in children with congenital hypothy­roidism // Clin. Immunol.— 2005.— Vol. 116.— P. 94—98.

Objective — to study of association between rpoB gene Mycobacterium tuberculosis and interleukins genes polymorphisms, C­-reactive protein in patients with multi­drug­resistant tuberculosis (MDR TB).
Materials and methods. Under our supervision were 87 patients with pulmonary tuberculosis (PT) and 30 relatively healthy donors. Patients have been divided into two groups, with and without pulmonary MDR TB. Were studied areas of interleukin IL­2 genes, polymorphism T330G, IL­4 — C589T and C-­reactive protein (CRP) — C3872T using the polymerase chain reaction. Level of cytokines (IL­2, IL­4) and CRP were studied in venous blood by ELISA method. Detection of rifam­picin­-resistance from DNA of Mycobacterium tuberculosis in sputum and rpoB gene  was performed by using Xpert MTB/RIF Assay.
Results and discussion. Changes of the secretion of IL­4, CRP and IL­2 was significantly associated with a mutation of  homozygotes and heterozygotes of C589T polymorphism of the IL4 gene, T330G — IL­2 and C3872T — CRP in patients with infiltrative PT. In patients with pulmonary MDR TB regarding the presence of rifampicin­-resistance rpoB gene MBT was found a close relationship with the heterozygous TG genotype T330G polymorphism of the gene IL­2, CT polymorphism C589T — IL­4 and CT polymorphism C3872T — CRP, which indicates a genetic predisposition to MDR TB against the corresponding changes of the background of interleukins and CRP.
Conclusions. For MDR TB is significantly more typical heterozygous genotype of mentioned above polymorphisms in cytokine genes on a background credible presence of rifampicin­-resistance rpoB gene MBT and the appropriate level of IL­2, IL­4 and CRP in blood serum.

Keywords: multi­drug resistant tuberculosis, cytokines, gene polymorphism, immunity, interleu­kins, rpoB gene, Mycobacterium tuberculosis, C­reactive protein.

List of references:  
1.    Барбова А.І., Журило О.А., Жеребко Н.М. та ін. Порядок використання молекулярно-генетичних методів у лабораторіях з діагностики туберкульозу в Україні: метод. реком. Державної установи «Національний інститут фтизіатрії і пульмонології ім. Ф. Г. Яновського НАМН України».— К., 2014.— 18 с.
2.    Быстрое внедрение диагностического теста Xpert MTB/RIF: технические и операционные рекомендации. Вопросы практического применения: руководство / Всемирная организация здравоохранения.— Женева, 2011.— 41 с.
3.    Имангулова М.М., Карунас А.С., Хуснутдинова Э.К. Моле­кулярно-генетические аспекты туберкулеза легких // Мед. генетика.— 2005.— № 11.— Р. 505—510.
4.    Коненков В.И., Ракова И.А., Авдошина В.В. и др. Связь аллельных вариантов промоторных участков генов IL-2 (T-330G), IL-4 (С-590Т) и IL-10 (С-592А) с уровнем спонтанной продукции цитокинов in vitro мононуклеарными клетками периферической крови здоровых жителей Сибири европеоидного происхождения // Мед. генетика.— 2006.— № 3.— С. 46—50.
5.    Лапач С.Н., Чубенко А.В., Бабич П.Н. Статистические ме­­тоды в медикобиологических исследованиях с использованием Excel.— К.: Морион, 2000.— 320 с.
6.    Чернушенко Е.Ф., Процюк Р.Г. Противотуберкулезный иммунитет: ч. І // Укр. пульмонол. журн.— 2010.— № 4.— С. 53—58.
7.    Azad A.K., Sadee W., Schlesinger L.S. Innate immune gene polymorphisms in tuberculosis // Infect. Immun.— 2012.— Vol. 80, N 10.— P. 3343—3359.
8.    Bellam R. Genome-wide approaches to identifying genetic factors in host susceptibility to tuberculosis // Microbes. Infect.— 2006.— Vol. 8, N 4.— P. 1119—11123.
9.    Bloom B.R., Trach D.D. Genetics and developing countries // BMJ.— 2001.— Vol. 28, N 322 (7293).— P. 1006—1007.
10.    Bulat-Kardum L.J., Etokebe G.E., Lederer P. et al. Genetic Polymorphisms in the Toll-like Receptor 10, Interleukin (IL)17A and IL17F Genes Differently Affect the Risk for Tuberculosis in Croatian Population // Scand. J. Immunol.— 2015— Vol. 82, N 1.— P. 63—69.
11.    Chong Wang, Chang-Ming Liu, Li-Liang Wei et al. A Group of Novel Serum Diagnostic Biomarkers for Multidrug-Resistant Tuberculosis by iTRAQ-2D LC-MS/MS and Solexa Sequencing // Int. J. Biol. Sci.— 2016.— Vol. 12, N 2.— P. 246—256.
12.    Fortún J., Martín-Dávila P., Gómez-Mampaso E. et al. Extra-pulmonary tuberculosis: a biomarker analysis // Infection.— 2014.— Vol. 42, N 4.— P. 649—654.
13.    Global tuberculosis report 2014: WHO report 2014 / World Health Organization.— Geneva, Switzerland, 2014.— 118 p.
14.    Hu Y., Wu L., Li D. et al. Association between cytokine gene polymorphisms and tuberculosis in a Chinese population in Shanghai: a case-control study // BMC Immunol.— 2015.— N 16.— P. 8.
15.    Ke Z., Yuan L., Ma J. et al. IL-10 Polymorphisms and Tubercu­losis Susceptibility: An Updated Meta-Analysis // Yonsei Med. J.— 2015.— Vol. 56, N 5.— Р. 1274—1287.
16.    Lindenau J.D., Guimarães L.S., Friedrich D.C. et al. Cytokine gene polymorphisms are associated with susceptibility to tu­­berculosis in an Amerindian population // Int. J. Tuberc. Lung Dis.— 2014.— Vol. 18, N 8.— P. 952—957.
17.    Multidrug-resistant TB (MDR-TB): 2014 Update / World Health Organization.— Geneva, Switzerland, 2014.— 2 p.
18.    Pavan N.K., Anuradha R., Andrade B.B. et al. Circulating biomar­kers of pulmonary and extrapulmonary tuberculosis in children // Clin. Vaccine Immunol.— 2013.— Vol. 20, N 5.— P. 704—711.
19.    Sivangala R., Ponnana M., Thada S. et al. Association of cytokine gene polymorphisms in patients with tuberculosis and their household contacts // Scand. J. Immunol.— 2014. Vol. 79, N 3.— P. 197—205.
20.    Technical Guidance Group of the Fifth National TB Epi­demiological Survey, The Office of the Fifth National TB Epidemiological Survey. The fifth national tuberculosis epide­miological survey in 2010. Chin. J. Antituber.— 2012.— Vol. 34, N 8.— P. 485—508.

Objective — to study and draw parallels of immunological disorders in patients with newly diagnosed chemo sensitivity and multi destructive pulmonary tuberculosis (VDDTB).
Materials and methods. Complex research of cellular and humoral immunity was performed in 31 patients with chemo sensitivity VDDTB of lung (reference group) and in 44 patients with pulmonary multi resistant VDDTB of lung (study group).
Results and discussion. In the vast majority of patients with first diagnosed multiresistant destructive pulmonary tuberculosis showed inhibition of phagocytic immunity. In case of chemo sensitive TB — phagocytic immune system was activated. The combination of quantitative and functional disorders in the T­cell immunity is ascertained in 72.7 % of patients from the primary and 54.8 % from the reference group of people.
Symptoms of complete tuberculin allergy in vitro and a reinforced antibody production (ІgM ІgG, ІgE) are in 1,4 times more likely to ascertained in patients with multiresistant TB, compared with the chemosensiti­ve lung tuberculosis.
Conclusions. In patients with newly diagnosed multiresistant destructive pulmonary tuberculosis specific weitght and intensity of the disorders in the immune system is significantly higher than in patients with tuberculosis chemosensitivity.

Keywords: immunity, chemosensitivity, multidrug newly diagnosed pulmonary tuberculosis.

List of references:  
1.    Баласанянц Г.С. Развитие эпидемического процесса при туберкулезе: влияние внешних и внутренних факторов // Мед. акад. журн.— 2014.— Т. 14, № 2.— С. 55—59.
2.    Вахидова Г.А., Еремеев В.В., Убайдуллаева А.М. Иммуно­логические механизмы патогенеза туберкулеза // Пробл. туб.— 1991.— № 5.— С. 42—43.
3.    Копелян И.И., Григорьева М.П. Разработка микромодификаций культивирования клеток крови человека // Бюл. экспер. биол. и мед.— 1972.— № 8.— С. 119—122.
4.    Литвиненко Н.А. Фактори ризику щодо виникнення розширеної та прерозширеної резистентності МБТ серед пацієнтів з мультирезистентним туберкульозом // Сучаснi медичнi технології.— 2014.— № 2.— С. 36—42.
5.    Мельник В.М., Новожилова І.О., Матусевич В.Г. Хіміо­резистентний туберкульоз: стан проблеми в Україні // Укр. мед. часопис.— 2013.— № 6.— С. 26—28.
6.    Мордык А.В., Батищева Т.Л., Брюханова Н.С., Пузыре­ва Л.В. Влияние иммунологических нарушений на исход впер­вые выявленного инфильтративного туберкулеза у со­­циально сохранных пациентов // Инфекция и иммунитет.— 2014.— Т. 4, № 4.— С. 353—358.
7.    Новожилова І.О., Мельник В.М., Матусевич В.Г. Світові тенденції зростання резистентності мікобактерій туберкульозу до протитуберкульозних препаратів (огляд літератури) // Укр. мед. часопис.— 2012.— № 6.— С. 26—28.
8.    Сахно Л.В., Тихонова М.А., Курганова Е.В. и др. Т-клеточная анергия в патогенезе иммунной недостаточности при туберкулезе легких // Проблемы туберкулеза и болезней легких.— 2004— № 5.— С. 23—31.
9.    Фещенко Ю.І., Мельник В.М. Організація контролю за хі­­міо­резистентним туберкульозом із резистентністю до антимікобактеріальних препаратів.— К.: Здоров’я, 2013.— 704 с.
10.    Черенько С.О. Імунопатогенез туберкульозу // Астма та алергія.— 2013.— № 1.— С. 32—37.
11.    Чернушенко Е.Ф., Панасюкова А.Р. Иммунологические ме­­ханизмы прогрессирования туберкулеза // Екологічні проб­леми у фтизіатрії і пульмонології : Матеріали науково-практичної конференції.— К., 2004.— С. 222—225.
12.    Чернушенко Е.Ф., Процюк Р.Г. Противотуберкулезный иммунитет // Укр. пульмонол. журн.— 2010.— № 4.— С. 53—58.
13.    Чукалин А.Г. Новые данные иммунных реакций при туберкулезе // Рос. мед. журн.— 2004.— Т. 12, № 2.— С. 88—90.
14.    Aleman M., Garcia A., Saab M. et al. Mycobacterium tuber­culosis— inducet activation accelerates apoptosis in peripheral blood neutrophils from patients with active tuberculosis // Am. J. Respir. Cell Mol. Biol.— 2002.— Vol. 27.— P. 583—592.
15.    Ciobanu S., Lesnic E., Todoriko L. et al. Predictive exogenous conditions for tuberculosis treatment default // Туберкульоз, легеневі хвороби, ВІЛ-інфекція.— 2015.— Vol. 3 (22).— С. 35—38.
16.    Flynn J.L., Chan J. Immune evasion by Mycobacterium tu­­berculosis: living with the Enemy // Curr. Opin. Immunol. Cell Mol. Biol.— 2003.— Vol. 15.— P. 450—455.
17.    Wahab F. et al. Risk factors for multi-drug resistant tuberculosis in patients at tertiary care hospital, Peshawar // J. Coll. Physicians Surg. Pak.— 2009.— Vol. 19 (3).— P. 162—164.

Objective — to optimize etiotrop and pathogenic treatment of patients with newly diagnosed pulmonary tuberculosis (NDTB) depending on the state of the absorption function of the small intestine and microbiocenosis of the large intestine.
Materials and methods. A controlled study included 73 patients with NDTB who were examined by lactulos­mannitol test and bacteriological, mycological investigation of the colon cavity contents. Patients with moderate and severe malabsorption were included in group 1, patients with mild malabsorption and normal absorption — in group 2. Each group was divided into main (A) and control (B) subgroups. Subgroup 1A received inject-able forms of  isoniazid and rifampicin as the standard etiotropic treatment schemes (SETS), as well as pre­ and probiotics, the subgroup 2A — pre­ and probiotic in addition to oral SETS. Control subgroups received only SETS orally.
Results and discussion. Conversion of sputum smear in subgr. 1A in the end of the intensive phase of treatment took place in 100 % of patients, in the control subgr. 1B — in 53.9 % of patients (p < 0.05), in the subgr. 2A — in 95.8 % of patients, which was 11.6 % more in comparison with the subgr. 2B (p > 0.05). Term of  bacteriological conversion in subgr. 1A was reduced by 0.22 months compared to subgr. 1B (p > 0.05), in subgr. 2A — by 0.14 months compared to subgr. 2B (p > 0.05). Positive dynamics of the X­-ray at the end of 2 months of treatment were observed in subgroups 1A and 2A in 64.7 and 66.7 %, respectively, which was significantly higher than in control subgroups (p < 0.05).
Conclusions. Optimization of etiotropic and pathogenic treatment of newly diagnosed tuberculosis based on the state of absorption in the small intestine and microbiocenosis of the large intestine can significantly improve the efficacy of the treatment of this disease.

Keywords: tuberculosis, malabsorption syndrome, colon dysbiosis, intestinal permeability.

Objective — to study the peculiarities of tuberculosis of peripheral lymph nodes (PLN) combined with pulmonary tuberculosis (PTB) and determine the causes of late diagnosis of the disease in children.
Materials and methods. 137 case histories of children aged from 0 to 15 with local forms of extrapulmonary tuberculosis treated in a specialized children’s hospital in 1988—2015 were analysed.
Results and discussion. TB of PLN was found in (35.8 ± 6.8) % (49) of patients out of 137 children with extrapulmonary TB. In (77.6 ± 6.7) % of children TB of PLN was combined with PTB, in addition, tuberculosis of intrathoracic lymph nodes ((81.6 ± 6.9) %) prevailed and 7.9% of patients had miliary tuberculosis. The disease was diagnosed ((91.8 ± 4.0) %) while seeking medical help. Before the admission to the specialized hospital (73.5 ± 7.3) % of children were treated in general hospitals. In (44.9 ± 10.8) % of cases the disease was diagnosed late. The disease developed in children with low reactivity of the organism ((77.6 ± 6.7) %) and in children who were not vaccinated with BCG vaccine and those vaccinated inefficiently (63.3 ± 8.6) %.
Conclusions. The peculiarities of combined forms of TB of PLN are great variety of affected lymph nodes, lesions of several groups of lymph nodes, slightly higher tendency to form conglomerates and location of affected lymph nodes in chain pattern, combining with miliary tuberculosis and meningoencephalitis. The cause for late diagnosis of tuberculosis was insufficient vigilance of doctors in relation to tuberculosis, the lack of information about the source of infection and reduced sensitivity to tuberculin.

Keywords: tuberculosis of peripheral lymph nodes, respiratory tuberculosis, diagnosis, children.

List of references:  
1.    Аксенова В.А. Внелегочные формы туберкулеза у детей в России (эпидемиология, клинические формы и их наблюдение) // Пробл. туб.— 2001.— № 4.— С. 6—9.
2.    Баринов В.С., Прохорович Н.А., Иванова Т.Н., Семен­чен­ко П.В. Особенности туберкулеза периферических лимфатических узлов при специфическом процессе в органах дыхания // Пробл. туб. и бол. легких.— 2003.— № 5.— С. 21—23.
3.    Білогорцева О.І. Епідеміологічна ситуація щодо туберкульозу у дітей в Україні та шляхи удосконалення надання протитуберкульозної допомоги дітям // Совр. педиатр.— 2014.— № 5.— С. 22—26.
4.    Мотанова Л.Н., Безуглая С.Ю. Эпидемиологические и клинические аспекты внелегочного туберкулеза у детей и подростков в Приморском крае // Пробл. туб.— 2004.— № 1.— С. 5—8.
5.    Охорзина Н.А. Диагностика и лечение туберкулеза периферических лимфатических узлов у детей и подростков // Пробл. туб.— 2003.— № 1.— С. 36—39.
6.    Чеботарева А.А., Чеботарева Т.В., Облогина Л.И. и др. Методы выявления и клиническая характеристика внелегочного туберкулеза у детей из групп риска // Пробл. туб. и бол. легких.— 2008.— № 4.— С. 11—17.
7.    Swaminathan S., Rekha В. Pediatric tuberculosis: global overview and challenges // Clinical Infectious Diseases.— 2010.— May 15.— N 50 (Supplement 3).— P. 184—194.— Режим доступу: http://cid.oxfordjournals.org/content/50/Supplement_3/S184.full.pdf+html.

Objective – to evaluate the results of pulmonary tuberculosis depending on the availability of tissue dysplasia 5 years after treatment.
Materials and methods. The results of pulmonary tuberculosis in 255 people were studied, including 65.1 % of phenotypic signs of connective tissue dysplasia.
Results and discussion. After suffering a pulmonary tuberculosis in 33.7 % of patients with CTD were found large residual changes, in patients without CTD – at 19.1 %. In 10.2 % of people with CTD was detected resistance in 16.2 % — a failure of treatment, 9 % — recurrences, 4.7 % of them died, while only 2.2 % of patients without CTD marked resistance.
Conclusions. Unfavorable course of the process observed in 40.2 % of patients with CTD and 2 % — without CTD.

Keywords: respiratory tuberculosis, connective tissue dysplasia.

List of references:  
1.    Абакумова Л.Н. Клинические формы дисплазии соединительной ткани у детей.— СПб, 2006.— 36 с.
2.    Баклунов В.В. Клініко-імунологічні ообливості рецидивуючого бронхіту у дітей з ситемною дисплазією сполучної тканини): автореф. дис. …канд. мед. наук.— Харків, 2007.— 21 с.
3.    Василенко Г.П. Диспластикозависимые изменения органов дыхания // Медицина и образование Сибири.— 2010.— № 3.— С. 21—22.
4.    Ерохин В.В. Клиническая биология легких в норме и при патологии / Под ред. В.В. Ерохина, Л.К. Романовой.— М., 2000.— С. 209—221.
5.    Ерохин В.В. О некоторых механизмах патогенеза туберкулеза // Туберкулез и болезни легких.— 2009.— № 11.— С. 3—8.
6.    Клеменов А.В. Недифференцированная дисплазия соединительной ткани.— М.: Информатех, 2006.— 120 с.
7.    Марушко Ю.В. Синдром дисплазии соединительной ткани у детей // Совр. педиатр.— 2005.— № 4.— С. 167—171.
8.    Омельченко Л.И., Николаенко В.Б. Дисплазия соединительной ткани у детей // Doctor.— 2004.— № 1.— С. 44— 47.
9.    Петренко В.І. До міжнародного дня боротьби з туберкульозом: «Охопити три мільйони: виявити, лікувати, вилікувати туберкульоз» //Туберкульоз, легеневі хвороби, ВІЛ-ін­фек­ція.— 2014.— № 1 (16).— С. 3—6.
10.    Петренко В.І., Процюк Р.Г. Проблема туберкульозу в Україні // Туберкульоз, легеневі хвороби, ВІЛ-інфекція.— 2015.— № 2 (21).— С. 3—5.
11.    Фещенко Ю.І., Черенько С.О., Барбова А.І. Туберкульоз із розширеною резистентністю: епідеміологічні аспекти, проб­леми діагностики і лікування // Укр. пульмонол. журн.— 2013.— № 3.— С. 31—33.
12.    Фещенко Ю.І., Мельник В.М., Турченко Л.В. Концепція реформування протитуберкульозної служби і оптимізації протитуберкульозних заходів в Україні (проект) // Укр. пульмонол. журн.— 2015.— № 1.— С. 5—9.

Objective — to set the allele status of the genes of bio transformation of xenobiotics glutathione-­S-transferase class T1 (GSTT1) and M1 (GSTM1) in patients with pulmonary tuberculosis.
Materials and methods. 100 patients with newly diagnosed pulmonary tuberculosis were hospitalized in Chernivtsi region TB Dispensary. The control group consisted of 50 healthy individuals. Genomic DNA was released from whole venous blood. Polymorphic sites GSTM1 and GSTT1 multiplex isolated by polymerase chain reaction, according to the protocol for the momentary polymorphism analysis by M. Arana et all (1996). Deletion of the gene corresponds to the absence of the corresponding strips on electrophoregram. For statistical analysis of data STATISTICA program las used, version 10.0.228.8 (Stat­Soft, Inc.).
Results and discussion. In 39.99 % of surveyed there a mutation in the promoter region of genes studied the GST (20.55 % in patients with tuberculosis and 16.44 % healthy), among them, more than half (64.81 %) are carriers of pathological 0/0 genotype GSTM1 gene haplotype, whereas the combination of a homozygous mutation of the GSTT1 0/0 occurs in 2.33 times less, and is almost one in three (27.78 %) of the surveyed. 4.17 % of patients with pulmonary tuberculosis are carriers of abnormal genotypes of both isoforms of GST genes.
Conclusions. The favorable combination of functional alleles in the haplotype is characterized by the frequent occurrence of lung VDTB to 26.09 % (c2 = 4.37; p = 0.037) in a mild clinical course, against the backdrop of a liquid co­- and poly-morbidity (on 31.01 %, (c2 = 5.53, p = 0.019) and 31.38 % (c2 = 4.07; p = 0.044), respectively and more likely arresting of bacteriological 60 dose of 18,40% (c2 = 3.59; p = 0.052) and 45.64 % (p = 0.002), respectively.

Keywords: tuberculosis, GST, polymorphism, genes.

List of references:  
1.    Запорожан В.М., Бажора Ю.І., Крисюн В.Й. та ін. Молеку­лярна епідеміологія.— Одеса: ОДМУ, 2009.— 356 с.
2.    Kasthurinaidu S.P., Ramasamy T., Ayyavoo J. et al. GST M1-T1 null allele frequency patterns in geographically assorted human populations: a phylogenetic approach // PLoS One.— 2015.— Vol. 10 (4).— P. 23—27.
3.    Maggie Ramzy M., Mohei El-Din Solliman M., Hany Abdel-Hafiz A. et al. Genetic polymorphism of GSTM1 and GSTP1 in lung cancer in Egypt// Intern. J. Of Collabor. Research on Intern. Med. &Public Health.— 2011.— Vol. 3, N 1.— P. 41—51.
4.    Teixeira R.L., Morato R.G., Cabello P.H. et аl. Genetic po­­lymorphisms of NAT2, CYP2E1 and GST enzymes and the occurrence of antituberculosis drug-induced hepatitis in Bra­zilian TB patients // Mem. Inst. Oswaldo. Cruz.— 2011.— Vol. 106 (6).— P. 716—724.

The relevance of the problem is conditioned by the complexity of differential diagnosis of the etiology of pleural effusion (process).
Objectives — share the features of the Lyme disease that manifest the syndrome of pleural effusion, with further neurological disorders and lesions of the heart, leading to death.
Materials and methods. Under the supervision of the authors were two patients with Lyme borreliosis, accompanied by syndrome of pleural effusion.
Results and discussion. The disease and its manifestation looked like pneumonia. The process involved the cardiovascular system, the joints and the spinal cord, as well as the right pleural cavity.
Conclusions. Syndrome of pleural effusion may be one of the manifesting syndromes of Lyme disease. Only true and professionally assembled epidemiological history may give reasons to suspect Lyme disease and carry out specific studies to detect antibodies to the pathogen of borreliosis by IFA.
False collected history are not allowed for timely diagnosis of the disease in both patients.

Keywords: syndrome of pleural effusion, Lyme disease, diagnostics.

List of references:  
1.    Болецька Т.О., Чемич М.Д. Епідеміологічна ситуація з Лайм-бореліозу в Сумській області // Інфекційні хвороби.— 2014.— № 3 (77).— С. 82—87.
2.    Дужий І.Д. Клінічна плеврологія.— К.: Здоров’я, 2000.— 382 c.
3.    Дужий І.Д. Труднощі діагностики хвороб плеври.— Суми: Мрія, 2007.— 560 c.
4.    Завалицина И.А., Спирина Н.Н., Бойко А.Н. Хронические нейроинфекции.— М., ГЭОТАР-Медиа, 2011.— 560 с.
5.    Зінчук О.М. Безеритемні форми лайм-бореліозу: важливість своєчасної діагностики // Наук. вісн. Ужгородського університету. Серія «Медицина».— 2008.— № 34.— С. 60—62.
6.    Зінчук О.М. Безсимптомний перебіг лайм-бореліозу у робітників професійних груп із високим ризиком зараження // Інфекційні хвороби.— 2014.— № 2.— С. 39—42.
7.    Куляс С.М. Сучасний погляд на особливості специфічної діагностики, лікування та профілактики лайм-бореліозу // Biomedical and biosocial anthropology.— 2013.— № 20.— С. 245—251.
8.    Малый В.М., Шепелева Н.В., Волобуева О.В., Гриненко В.А. Лайм-боррелиоз: современное состояние проблемы // Междунар. мед. жур.— 2009.— Т. 15, № 1 (57).— С. 123—126.
9.    Наказ МОЗ України від 16.05.2005 № 218 «Про посилення заходів з діагностики та профілактики іксодових кліщових бореліозів в Україні».
10.    Никифоров А.С., Коновалов А.Н., Гусев Е.И. Клиническая неврология: в трех томах.— Т. ІІ.— М.: Медицина, 2002.— 792 с.
11.    Федонюк Л.Я., Чабан Г.П., Рибіцька Л.Н., Авсюкевич О.С. Епідеміологічна характеристика, особливості клінічного перебігу та діагностики системного кліщового бореліозу в Тернопільській області // Таврический медико-биологический вестник.— 2013.— Т. 16, № 1, Ч. 2 (61).— С. 198—202.
12.    Чемич М.Д., Болецька Т.О., Христенко Г.І. Клініко-епіде­міологічні особливості іксодового кліщового бореліозу на Сумщині // Профілакт. мед.— 2011.— № 4.— С. 56—59.
13.    Hsiang-Cheng Cheng, Chieng-Ming Shih, Jenn-Haung Lai, Li-Lian Chao, San-Yuan Kuo, Deh-Ming Chang. Pleural effusion as a manifestation of Lyme disease // The Journal Of Reumatology.— 2004.— N 4.— P. 811— 813.

Despite the successes that have been achieved over the last 20 years in diagnosis and treatment of pulmonary tuberculosis, the current problems in phthisiatry are extrapulmonary tuberculosis, including special attention needs tuberculous otitis media.
In case of extrapulmonary tuberculosis otitis there are a number of features which prevent timely diagnosis and treatment of this disease, which may eventually lead to sequestration not only the tympanic cavity, auditory bones, but with the formation of the labyrinth fistula and intracranial complications. Hence the urgency have the application of additional methods — namely, computer tomography of the temporal bone in complex with clinical and audiometric studies for the diagnosis of extrapulmonary tuberculosis otitis media and evaluate the treatment of patients.
In the article clinical case demonstrated the complexity of diagnosis and treatment of extrapulmonary tuberculous otitis media.

Keywords: extrapulmonary tuberculous otitis media, computer imaging, diagnostics, treatment.

Objective — to study of the possibility of development the drug­resistant forms of tuberculosis pleurisy on the basis of resistance of Mycobacterium tuberculosis.
Materials and methods. The authors examined 5 clinical cases of tuberculous pleurisy, confirmed histologically and micro-biologically.
Results and discussion. The term of diagnosis of pleurisy was in the range of 2—5 months. In general, the specific nature of the disease was only verified after its prolongation no the type of tuberculosis spondylitis in every 5 people and after addition of pulmonary process to the spinal osteomyelitis in 3 people. Moreover, MDR TB was diagnosed in 2 patients. The process was established after 4 months of differentiation. In one of the patients a multiple organ lesions ended lethally, in the other — with the transfer to palliative therapy. In two patients the process was stabilized and ended with the formation of fibrous bone ankylosis of the spine. The fifth patient remains on antibacterial therapy of the I category.
Conclusions. Tuberculous pleurisy may be caused by primary resistant mycobacteria, a belated detection of the disease can be complicated by multiple organ and extrapulmonary tuberculosis. The effectiveness of treatment of the last depends on the time of diagnosis of the process.

Keywords: рleurisy, delay, resistance, effectiveness of treatment.

List of references:  
1.    Дужий І.Д. Труднощі діагностики хвороб плеври : монографія.— Суми: Мрія, 2007.— 560 c.
2.    Клішина Л.С., Баранова В.В., Полякова В.Г., Стоянова О.О., Миронова Л.А. Аналіз первинного виходу на інвалідність хворих на позалегеневий туберкульоз у луганській області за період 2007—2009 роки // Укр. мед. альманах.— 2011.— Т. 14, № 5.— С. 78—80.
3.    Корецкая Н.М. Эпидемиология, патогенез и патоморфология остропрогрессирующего туберкулеза легких // Сиб. мед. журн.— 2011.— Т. 101, № 2.— С. 5—8.
4.    Лискина И.В. Особенности смертельных исходов при туберкулезе легких у взрослых пациентов высокоспе­циали­зи­рованного медицинского учреждения (по данным клинико-патологоанатомического анализа) // Туберкульоз, легеневі хвороби, ВІЛ-інфекція.— 2014.— № 3.— С. 31—38.
5.    Лискина И.В. Туберкулезные плевриты: эпидемиологичес­кие и клинико-анатомические аспекты, современное состояние проблемы в Украине // Укр. пульмонол. журн.— 2004.— № 1.— С. 47—50.
6.    Маргітич В.О., Дудник А.Б. Мультирезистентний туберкульоз з поліорганним ураженням // Укр. мед. часопис.— 2010.— № 3.— С. 88—89.
7.    Опанасенко Н.C., Лискина И.В. Туберкулезный плеврит у больных разного возраста: эпидемиологическое и клинико-анатомическое исследование // Пробл. старения и долголетия.— 2004.— Т. 13, № 2.— C. 178—186.
8.    Рабухин А.Е. Туберкулез органов дыхания.— М.: Медицина, 1976.— 328 с.
9.    Радиш Г.В. Ефективність і переносимість геміфлоксацину та інших фторхінолонів у режимах антимікобактеріальної те­­рапії хворих на мультирезистентний деструктивний туберкульоз легень // Туберкульоз, легеневі хвороби, ВІЛ-ін­­фекція.— 2014.— № 3.— С. 22—30.
10.    Семененков Ю.Л., Гарбулин А.Е. Плевриты.— К.: Здоров’я, 1983.— 181 с.
11.    Туберкульоз в Україні: Аналітично-статистичний довідник.— К., 2015.
12.    Фещенко Ю.І., Ільницький І.Г., Мельник В.М., Пана­­сюк О.В. Туберкульоз позалегеневої локалізації— К.: Логос, 1998.— 380 с.
13.    Фещенко Ю.І., Мельник В.М., Опанасенко М.С. Реорга­ні­зація, реструктуризація та реформування протитуберкульозної служби в Україні .— К., 2015.— 172 с.
14.    Хоменко А.Г. Болезни органов дыхания.— Медицина, 1996.— Т. 4.— 89 с.
15.    Черенько С.О., Гранкіна Н.В., Погребна М.В. Тривалість інтенсивної фази хіміотерапії при лікуванні хворих на мультирезистентний туберкульоз // Туберкульоз, легеневі хвороби, ВІЛ-інфекція.— 2015.— № 4.— С. 7—11.
16.    Falzon D., Gandhi N., Migliori G.B. et al. Resistance to fluo­roquinolones and second-line injectable drugs: impact on mul­tidrug-resistant TB outcomes // Eur Respir J.— 2013.— Vol. 42.— Р. 156—168
17.    Orenstein E.W., Basu S., Shah N.S., et al. Treatment outcomes among patients with multidrug-resistant tuberculosis: syste­matic review and meta-analysis // Lancet Infect. Dis.— 2009.— Vol. 9.— Р. 153—161.
18.    World Health Organization (WHO). Global tuberculosis report 2015 (WHO/HTM/TB/2015.22). Geneva: WHO; 2015. Available from: http://www.who.int/tb/publications/global_report/en/.

Idiopathic CD4+ T-­cell lymphopenia ­ heterogeneous immunological syndrome where decreased num­ber of lymphocytes with a phenotype CD3+CD4+ in the blood (< 300 cells/mcl and < 20 % of the total pool of T­cells) under normal other parameters of the immune status, and the absence of HIV­ infection. Among the representatives of the general population, this immune dysfunction occurs in 0.25—0.4 % of cases, but in hospitalized patients the proportion of immunodeficiency increases up to 5—6 %.
Idiopathic CD4+ T­-cell lymphopenia results in the development of severe recurrent opportunistic infections, including herpesvirus, papillomavirus, mycobacterial and pneumocystis, and leads to the formation non­protective immunity after vaccination. Many patients suffer from allergic, autoimmune, immunoinflammatory and neoplastic complications. Among autoimmune manifestations of this im­­munodeficiency prevails primary Sjogren’s syndrome. In 20 % of cases develop lymphoproliferative and solid tumors, often caused by opportunistic microorganisms. For the treatment of immunodeficiency currently proposed several immunotherapeutic agents including recombinant interferons­alpha and ­gamma, interleukin­2 and ­7, which have demonstrated efficacy in case reports and small controlled clinical trials. In very severe cases, transplantation of hematopoietic stem cells from a compatible donor is recommended.

Keywords: idiopathic CD4+ T-­cell lymphopenia, immunodeficiency, immunotherapy.

The article gives a reasoning in computer densitometry usage for the objectification of the results of investigation and the evaluation of treatment dynamics for patients with pulmonary tuberculosis. The principles of obtaining and software processing CT data are described.
On the basis of computer densitometry centers, the benefits of intravenous anti­-tuberculosis therapy were proven in comparison with oral standard therapy.

Keywords: computer tomography, software processing, densitometry, anti­tuberculosis therapy.

List of references:  
1.    Гуменюк Г.Л. Метод комп’ютерної томографічної денситометрії легень в алгоритмі лікування хворих на саркоїдоз // Журн. НАМН України.— 2015.— № 1, Т. 21.— С. 103—107.
2.    Кузнецова Н.Ю. Мультиспиральная компьютерная томография с применением цифровой денситометрии и цветового картирования плотности в комплексной диагностике хронической обструктивной болезни легких: автореф. дис. …канд. мед. наук.— СПб, 2009.— 24 с.
3.    Лобанов М.Н. Дифференциальная диагностика шаровид­ных образований легких при мультиспиральной компьютерной томографии на основе многомерной обработки денситометрических показателей: автореф. дис. …канд. мед. наук.— Барнаул, 2013.— 22 с.
4.    Льянова З.А. Различные формы туберкулеза на КТ высо­кого разрешения // Сб. науч. трудов Ингушского государственного университета.— Вып. 3.— Магас.— 2004.— С. 78—94.
5.    Льянова, З.А. Инфильтративный туберкулез легких на компьютерной томографии высокого разрешения: матер. Всерос. науч. форума «Радиология.— 2005.— М., 2005.— С. 245-246.
6.    Ратобыльский Г.В., Лазарева Я.В., Серова Е.В. Цифровая рентгенография высокого разрешения в выявлении и диагностике туберкулеза органов дыхания в настоящее время // Пробл. туб. и болезней легких.— 2006.— № 1.— С. 35—42.
7.    Тлеубаева Ж.О. Роль цифровых лучевых методов в исследовании и дооперационной диагностике патологии органов грудной клетки: Матер. III Всерос. нац. конгресса лучевых диагностов и терапевтов.— М., 2009.— 528 с.
8.    Фещенко Ю.И., Линник Н.И. Многосрезовая компьютерная томография во фтизиатрии и пульмонологии: программное обеспечение // Журн. НАМН України.— 2014.— Т. 20, № 4.— С. 453—458.
9.    Хофер М. Компьютерная томография: базовое руководство.— М.: Мед. лит., 2008.— 224 с.
10.    Gevenois P.A., de Maertelaer V., de Vuyst et al. Comparison of computed density and macroscopic morfometry in pulmonari emphyzema // Am. J. Respir. Crit. Care Med.— 1995.— Vol. 152, N 2.— P. 653—657.